Case Study 1

Vicky is in her mid-fifties and is divorced with a grown-up family. Much to her delight, they are now providing her with much-longed-for grandchildren. While she has friends and some family round about with whom she has regular contact, Vicky lives on her own. Her interests include gardening, theatre, literature - both reading and writing herself - as well as her pets and her faith.

Vicky has a diagnosis of paranoid schizophrenia and has spent a lot of time in the Royal Edinburgh Hospital over the years due to prolonged periods of poor mental health. She had to give up work a number of years ago because of this. Vicky has been receiving daily support for about three years. This support includes: assisting Vicky with practical tasks; offering emotional support; and helping her to find ways to manage her mental health and general well-being.

One of the things Vicky receives support with is doing her weekly shopping. Crowded places heighten her paranoia, making her think that people are talking about her. You arrive at the house expecting Vicky to be ready to go, but instead she is pacing up and down, looking really distressed. When you ask what is wrong, she tells you there's no point in going shopping. When you ask why not, she tells you she won't need it, as the voices are reminding her what a bad person she is and that she doesn't deserve to live any more. You then notice that she has emptied all her medication into a pile on the coffee table.

You know that Vicky has obeyed her voices in the past, taking potentially fatal overdoses. When well, Vicky has very trusting relationships with all those involved in her support, especially you, but she finds it difficult to trust anyone when she is unwell. She has resolved not to go to hospital ever again.

Questions

What are you thinking? What is worrying you?

What is the first thing you are going to do or say?

How do you ensure that Vicky is kept safe and still respect her wishes and feelings? Do you have any right to intervene?